Physical therapy management of an athlete with a Kim lesion using physical agents, manual therapy, and therapeutic exercise: a case report.

BACKGROUND: Several operative procedures have been described for treating a Kim lesion. However, no physical therapy intervention has been documented as conservative treatment for these cases. OBJECTIVE: The purpose of this report was to describe a physical therapy management protocol for an athlete with a Kim lesion. CASE DESCRIPTION: A 22-year-old female volleyball athlete presented to physical therapy with an 8-month history of right shoulder pain when performing the serve and attack sports gestures. Pain was 5/10 on the visual analogue scale (VAS). Pain was localized along the glenohumeral joint, around the long head of the biceps brachii tendon, and at the subscapularis tendon insertion. Shoulder range of motion (ROM) was limited to flexion (150°), abduction (158°), and internal rotation (80°). Kim lesion was confirmed by clinical tests (Kim test and Jerk test) and via magnetic resonance imaging. Shoulder functional outcomes were verified through the University of California Los Angeles (UCLA) shoulder rating scale. Upper extremity sensorimotor control was verified in bimanual support by stabilometry on a baropodometer. Core function was assessed through a plank test and a side plank test. The 8-week course of treatment included manual therapy, physical agents, shoulder and scapular mobilizations, resistance and sensorimotor exercises, core strengthening, and functional exercises. OUTCOMES: Physical therapy interventions resulted in a decrease in VAS pain (3/10), an increase in shoulder ROM (10.8°) and in UCLA shoulder score (from 22 to 33 points), a reduction in the center of pressure displacement (27-56%), and an increase in plank test (45%) and side plank test (21-29%) performance. The athlete had a full return to sport after the treatment. CONCLUSION: We concluded that the protocol used for conservative management of Kim lesion resulted in clinical satisfactory physical and functional outcomes for the athlete.

Efeitos do resfriamento e aquecimento articular no desempenho funcional do ombro / Effects of cooling and heating on shoulder functional performance / Efectos del enfriamiento y del calentamiento articular del hombro en el desempeño funcional

INTRODUÇÃO: Um dos recursos mais utilizados na reabilitação de lesões musculoesqueléticas é a termoterapia por subtração de calor (crioterapia), enquanto a termoterapia por adição de calor é considerada o procedimento mais antigo de reabilitação física. Entretanto, há poucas evidências que tenham investigado os efeitos desses recursos sobre o desempenho de membros superiores. OBJETIVO: Comparar o efeito do resfriamento e do aquecimento articular sobre o desempenho funcional do membro superior. MÉTODOS: Trinta e quatro voluntários (22,23 ± 2,17 anos; 22,39 ± 2,53 kg/m2), de ambos os sexos, foram divididos aleatoriamente em um dos três grupos: 1) grupo crioterapia GCR (n=10): submetidos ao resfriamento articular por compressas frias; 2) grupo termoterapia - GTE (n=10): submetidos ao aquecimento articular por ondas curtas e 3) grupo controle - GCO (n=14), não submetidos a qualquer intervenção. Os voluntários foram avaliados, pré e pós-intervenção, quanto ao desempenho funcional de membros superiores por meio dos testes de estabilidade da extremidade superior em cadeia cinética fechada (TEESCCF) e das condições de equilíbrio em apoio bimanual sobre o baropodômetro. Ainda, os voluntários foram avaliados quanto ao desempenho funcional virtual por meio do jogo Mario Kart (Nintendo Wii (r) ). RESULTADOS: Houve melhora significativa nos valores pós-intervenção no TEESCCF para o GCR (p<0,001), GTE (p=0,002) e GCO (p=0,01). Não houve alteração significativa na área de deslocamento do centro de pressão na condição de olhos abertos, nos três grupos (p>0,05). Entretanto, na condição de olhos fechados, houve piora de desempenho para GTE (p=0,04) e melhora de desempenho para o GCO (p=0,02). Não houve alteração significativa no desempenho funcional virtual para os três grupos (p>0,05). CONCLUSÃO: Embora não tenha favorecido o desempenho funcional em todos os testes reais e virtuais utilizados, o resfriamento articular foi mais efetivo que o ...

INTRODUCTION: Thermotherapy by heat subtraction or cryotherapy is one of the most used resources in the physical rehabilitation whereas thermotherapy by addition of heat is considered as the oldest procedure in physical rehabilitation. However, there are few evidences regarding the effects of these physical agents on the performance of upper limbs. OBJECTIVE: To compare the effect of joint cooling and joint heating on functional performance of the upper limb. METHODS: Thirty-four subjects (22.23 ± 2.17 years old; 22.39 ± 2.53 kg/m2) of both genders were randomly assigned to one of the following three groups: 1) subjects who were submitted to joint cooling with cold compresses - CRG (n=10); 2) subjects who were submitted to joint heating by shortwave thermotherapy - THG (n=10) and 3) subjects who were not submitted to any intervention - control group - COG (n=14). Upper limb performance was assessed pre- and post-intervention by the closed kinetic chain upper extremity stability test (CKCUEST). Balance conditions were assessed in upper limb supporting on a pressure platform. Virtual performance was evaluated by Mario Kart Wii game (Nintendo Wii(r)). RESULTS: There was significant improvement in post intervention measurements in CKCUEST for both CRG (p<0.001), THG (p=0.002) and COG (p=0.01). There were no significant changes in the center of pressure area displacement with opened eyes in the three groups (p> 0.05). However, in the closed eyes condition, there was a worsened performance for THG (p=0.04) and improved performance for COG (p=0.02). No significant changes in virtual performance were observed for the three groups (p>0.05). CONCLUSION: Joint cooling was more effective than joint heating to maintain the upper limb muscle performance, especially in upper limb balance with closed eyes although it did not favor functional performance in all real and virtual tests. .

INTRODUCCIÓN: Uno de los recursos más utilizados en la rehabilitación de lesiones musculoesqueléticas es la termoterapia por sustracción de calor (crioterapia), mientras que la termoterapia por agregado de calor es considerada como el procedimiento más antiguo de la rehabilitación física. Entretanto, hay pocas evidencias de que se hayan investigado los efectos de esos recursos sobre el desempeño de miembros superiores. OBJETIVO: Comparar el efecto del enfriamiento y del calentamiento articular sobre el desempeño funcional del miembro superior. MÉTODOS: Treinta y cuatro voluntarios (22,23 ± 2,17 años; 22,39 ± 2,53 kg/m2), de ambos sexos, fueron divididos randómicamente a uno de los tres grupos: 1) grupo crioterapia GCR (n = 10) sometidos al enfriamiento articular por compresas frías; 2) grupo termoterapia - GTE (n = 10) sometidos al calentamiento articular por ondas cortas y 3) grupo control - GCO (n = 14), no sometidos a ninguna intervención. Los voluntarios fueron evaluados antes y después de la intervención, cuanto al desempeño funcional de los miembros superiores a través de los tests de estabilidad de la extremidad superior en cadena cinética cerrada (TEESCCF) y de las condiciones de equilibrio en apoyo bimanual en un baropodómetro. Además, los voluntarios fueron evaluados cuanto al desempeño funcional virtual a través del juego Mario Kart (Nintendo Wii(r)). RESULTADOS: Hubo mejora significativa en los valores post-intervención en TEESCCF para GCR (p <0,001), GTE (p = 0,002) y GCO (p = 0,01). No hubo alteración significativa en el área de desplazamiento del centro de presión en la condición de ojos abiertos, en los tres grupos (p> 0,05). Entretanto, en la condición de ojos cerrados, empeoró el desempeño de GTE (p = 0,04) y mejora en el desempeño funcional para el GCO (p = 0,02). No hubo alteración significativa en el desempeño funcional virtual para los tres grupos (p> 0,05). CONCLUSIÓN: A pesar de que no se haya favorecido ...